title: Utilization management in toxicology.
abstract: Recent upward trends in the prevalence of abuse of prescription drugs and illicit substances have resulted in increased demands for toxicology testing to support the emergency department and drug treatment in pain management programs. This review will discuss the challenges faced by clinical laboratories to manage the utilization of toxicology tests, particularly those ordered in managing poisoned patients in the emergency department and chronic pain patients on opioid therapy. Optimal utilization of toxicology tests to support the emergency department relies on selecting the appropriate tests for the patient, and the availability of the results in a timely fashion. Two tiers of toxicology testing systems with different requirements for turnaround time will be discussed. In patients with chronic pain urine drug testing, including screening and confirmation testing are used extensively in pain management to monitor patient compliance. A thorough understanding of the performance characteristics of the test methodologies and drug metabolism is a key to making a proper analytical and clinical interpretation of the test results and will contribute to effective utilization of these tests. In addition, the reimbursement system is an important factor in the decision making process for test selection utilization as significant costs can be incurred by both payers and patients. Collaboration, trust, and effective communication among clinicians, patients, and clinical laboratory professionals are essential for effective utilization of toxicology testing.
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, United States. Electronic address: yan1_zhang@urmc.rochester.edu.
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhang
authors.forename: Tai C
authors.initials: TC
authors.lastname: Kwong
mesh_terms: D064790:Clinical Laboratory Services / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data*; D019411:Clinical Laboratory Techniques / Q000191:economics / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D018675:Toxicity Tests / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*
keywords: 11-nor-9-carboxy(∆9)tetrahydrocannabinol; 2-ethylidene-1,5-dimethyl-3-3-diphenylpyrrolidine; 3,4-methylenedioxyamphetamine; 3,4-methylenedioxymethamphetamine; CLIA; Clinical Laboratory Improvement Amendments; ED; EDDP; EG; Emergency department; HCPCS; HPLC; Healthcare Common Procedure Coding System; LC; MDA; MDMA; MS; POCT; Pain management; Reimbursement; TAT; THCCOOH; Toxicology; UDT; Urine drug testing; Utilization management; emergency department; ethylene glycol; high pressure (performance) liquid chromatography; liquid chromatography; mass spectrometry; point-of-care testing; turnaround time; urine drug testing